Boston Marathon Bombing Response Reaffirms Lessons

Dr. Ricky Kue will present The Boston Marathon Bombings: Lessons Learned from the EMS Response at the World Trauma Symposium, hosted by NAEMT’s PHTLS Committee and EMS World Expo, September 9 in Las Vegas, NV. To register, visit WorldTraumaSymposium.com.

With any MCI, there are lessons to be learned from the response. The Boston Marathon bombings of Monday, April 15 are just one recent—though particularly stark—example of how sometimes those lessons don’t need to be new to have value.

Ricky Kue, MD, MPH, FACEP, associate medical director for Boston EMS, was the EMS physician assigned to the finish line medical tent at the time of the blasts and worked closely with EMS providers, doctors, nurses and other responders on scene and the Boston Athletic Association (BAA), which hosts the event, to coordinate initial medical care, triage and transport of victims to area hospitals.

Kue, also a major in the U.S. Army Reserve, was among the few who responded that day who likely had experience with true blast injuries: He was deployed in 2008 to Tikrit, Iraq with the 345th Combat Support Hospital as the clinical director of emergency services and in 2012 to Camp Buehring, Kuwait with the 126th Aviation Regiment as the task force flight surgeon. He offered EMS World some insight into how Boston had prepared itself for an MCI prior to the marathon bombings, and how responders handled the chaos of that day.

“Looking back, one of the things the public safety sector in the metro Boston region has done well since 9/11 is put a lot of its grant monies toward resources and infrastructure aimed specifically at developing MCI response capabilities,” Kue explains. “From EMS’ specific area of concentration, we’ve done a lot over the years in terms of thinking about surge capacity and standardizing the nuts and bolts of MCI response.”

Kue says Boston also goes beyond simply having a response plan in place—regular training and exercises happen one to two times per year within the department, in addition to regional exercises the agency participates in.

Those regional relationships also came in handy during the marathon response, Kue says, as many private and other agencies from outside metro Boston pitched in. The quick response was also no doubt because Boston has invested heavily into developing interoperable communications infrastructure, so all of Boston EMS’ partner agencies were able to be readily dispatched and assigned to staging areas. So while Boston EMS handled much of the immediate response on scene, additional providers were ready to go to assist with transport or providing cover in other areas of the city.

The advantages of a highly interoperable communications system also extended to talking with area hospitals, Kue says. Boston is unique—and lucky—to have five level 1 adult trauma centers and three level 1 pediatric trauma centers in its area. “So when we look at a regional response, it’s not just limited to an isolated hospital. The way our communications work is we can talk to all the hospitals, get an idea of their capacity and distribute patients so not just one institution gets overwhelmed or hits its capacity. We have complete command and control of where patients are going.”

Kue says a lot of the injuries he saw in the finish line medical tent were almost identical to the battlefield injuries he saw in Iraq—mixed blunt and penetrating trauma from projectiles and blast fragments. “If anything good came out of my experience, it was that we basically turned the medical tent at the finish line from a treatment center for running issues to a casualty collection point where we were stopping hemorrhage and getting people to definitive care,” Kue says.